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Humana Community HMO Diabetes and Heart (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Community HMO Diabetes and Heart (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Community HMO Diabetes and Heart (HMO C-SNP) in 2025, please refer to our full plan details page.
Humana Community HMO Diabetes and Heart (HMO C-SNP) is a HMO C-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Jefferson County. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Humana Community HMO Diabetes and Heart (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Humana Community HMO Diabetes and Heart (HMO C-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Humana Community HMO Diabetes and Heart (HMO C-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Humana Community HMO Diabetes and Heart (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $2.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4150.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Humana Community HMO Diabetes and Heart (HMO C-SNP) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and the pharmacy you use. For example, in the initial coverage phase, you'll pay a $5 copay for preferred generic drugs at a standard or preferred mail pharmacy. For specialty tier drugs, you will have no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, and you pay nothing for your Part D covered drugs.
Additional Benefits
The Humana Community HMO Diabetes and Heart (HMO C-SNP) plan offers a range of benefits with varying cost-sharing options. The plan covers inpatient and outpatient hospital services, primary care, specialist visits, and mental health services, with copays ranging from $0 to $350 depending on the service. Emergency, urgent, and worldwide emergency services are covered, as well as ambulance and transportation services. Additional benefits include coverage for preventive services, hearing, vision, and dental services, with specific copays and coinsurance amounts. The plan also covers home health services, home infusion services, and dialysis services. Medical equipment, diagnostic and radiological services, and skilled nursing facility services are also covered, but may require prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $350 copay for days 1-7, and no copay for days 8-90. For Inpatient Hospital Psychiatric, you will pay a $350 copay for days 1-6, and no copay for days 7-90. Additional Days for Inpatient Hospital-Acute are covered with no copay for days 91-999. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by Humana Community HMO Diabetes and Heart (HMO C-SNP). Outpatient hospital services have a copay between $0 and $350, while observation services have a $350 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay between $25 and $40.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Community HMO Diabetes and Heart (HMO C-SNP) plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a $315 copay. Transportation Services to a plan-approved health-related location are covered with no copay, up to 24 one-way trips per year via taxi, bus/subway, or medical transport, but any other health-related transportation is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Humana Community HMO Diabetes and Heart (HMO C-SNP). For Emergency Services, there is a $90 copay, and for Urgently Needed Services, there is a $65 copay; both have no coinsurance. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $90 copay.
Primary Care See details
Primary Care benefits cover services such as primary care physician services and chiropractic services, both with no copay. Specialist services have a $40 copay, while mental health and psychiatric services have a $40 copay for individual and group sessions. Physical therapy and speech-language pathology services have no copay, and additional telehealth benefits have a copay ranging from $0 to $65. Opioid treatment program services have a copay between $25 and $40.
Preventive Services See details
The Humana Community HMO Diabetes and Heart (HMO C-SNP) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, including Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with no copay. However, Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams have a $40 copay, while routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are partially covered, and the plan does not cover prescription hearing aids for the inner ear, outer ear, or over the ear. OTC hearing aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams with a copay between $0 and $40, and eyewear with no copay. Routine eye exams, contact lenses, and eyeglasses (lenses and frames) are covered, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a $4,000 maximum benefit per year. Medicare Dental Services require prior authorization and have a $40 copay. Oral exams, dental X-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services have no copay. Restorative services and prosthodontics, removable and fixed, have no copay, with 30% - 40% coinsurance. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. The cost sharing includes a $35 copay and between 0% and 20% coinsurance for Medicare Part B Insulin Drugs, with coinsurance between 0% and 20% for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs.
Dialysis Services See details
Dialysis Services are covered with prior authorization. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 15% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance, as well as Diabetic Equipment, including Diabetic Supplies with 20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts with no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures/tests with a copay between $0 and $105, and lab services with no copay. Radiological Services include coverage for diagnostic radiological services with a copay of up to $325, therapeutic radiological services with a copay of up to $40 and a coinsurance of at least 20%, and outpatient X-ray services with no copay.
Home Health Services See details
Home Health Services are covered by the Humana Community HMO Diabetes and Heart (HMO C-SNP) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but specific services including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Community HMO Diabetes and Heart (HMO C-SNP) plan, but require prior authorization. For days 1-20, the copay is $20 per day, and for days 21-100, the copay is $214 per day. Additional days beyond Medicare and non-Medicare-covered stays are not covered.
Other Services See details
The Humana Community HMO Diabetes and Heart (HMO C-SNP) plan covers acupuncture with a $40 copay and up to 20 treatments per year, and also covers over-the-counter items with a $600 maximum benefit. This plan also covers a meal benefit with no copay. However, this plan does not cover Dual Eligible SNPs with Highly Integrated Services.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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